Maternal drug addiction: From parenthood at risk to well-being

Background: Several studies show that maternal drug addiction is a specific condition of psychopathology often associated with other mental disorders (Casillas & Clark, 2002; Gerra & Frati, 2000; Walton & Roberts, 2004) and represents a condition of parenthood at risk (Suchman, McMahon, Slade, & Luthar, 2005; Pajulo, 2001). First, children born affected by drug use during pregnancy may have neurobiological risks for the fetus (Fisher, 2003), then dysfunctional caregiving models, related to parental substance abuse, may lead to a vulnerability in psychosocial development of the child (Molitor, Maves, & Ward, 2003; Eiden, 2001). Currently, communities residential treatments for addicted mothers and their children of the Veneto region take charge of both members of the dyad, providing services to both individual and dyadic therapeutic interventions. This paper presents a single case, representative of a wider project of research and intervention: the project focuses on diagnostic evaluations of the mother, the child and their relationship, and planning of interventions tailored to needs of each user. In this single case we illustrate the evaluations concerning dyadic interactions (mother-infant relationship) and also triadic interactions (mother-father-child relationship). Method: The single case concerns of: mother (41-year-old, drugaddicted), father (39-year-old), infant (25-months) and two health providers. First, diagnosis of maternal personality was investigated by the Reactive of Rorschach (Rorschach, 1921) and by the Structured Clinical Interview for DSMIV (SCID-II; First, Gibbon, Spitzer, Williams, & Benjamin, 1997), while the assessment of attachment representations is investigated by the Adult Attachment Interview (AAI; George, Kaplan & Main, 1985). Second, regarding the assessment of the infant we investigated: the level of adaptive functioning was by using the Vineland Adaptive Behavior Scales (VABS; Sparrow, Balla, & Cicchetti, 1984), the symptomatology by using the Achenbach System of Empirically Based Assessment (ASEBA; Achenbach, 1991), and the quality of attachment relationships using the Attachment Q-Sort (AQS; Waters, 1987). Finally, the quality of family interactions was assessed by using the Lausanne Trilogue Play (LTP; Fivaz-Depeursinge & Corboz-Warnery, 1999). Results: Data show that the dyadic relationship is seriously compromised, in fact a) the mother has a pathological structure of personality, characterized by ego deficiencies in managing affects, dissociative episodes, and meta-cognitive processes compromised, b) the child show a delay in adaptive functioning, a multifaceted set of symptoms and insecure attachment. On the other hand, the father seems to be an important resource for family setting, acting as a supportive adult in shared activities and furthering more functional family interactions.